CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects
CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects
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DOI：
10.1038/sj.ijo.0803000
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发表时间：
2005-10-01
影响因子：
4.9
通讯作者：
Karlsson, FA
中科院分区：
文献类型：
--
作者：
Holdstock, C;Lind, L;Karlsson, FA
目的：肥胖通常与胰岛素抵抗、血脂异常、高血压和心血管疾病风险增加相关，反映在炎症标志物升高，特别是C反应蛋白（CRP）。胰岛素抵抗或肥胖本身在多大程度上导致CRP水平升高尚不清楚。在病态肥胖患者中，胃旁路手术引起体重的显著变化并改善代谢，从而为炎症标志物调节的研究提供了信息材料。设计：病态肥胖受试者炎症标志物的前瞻性手术干预研究。总共有66名肥胖受试者，平均年龄39岁，平均体重指数（BMI）45 kg/m2，在Roux-en-Y胃旁路术（RYGBP）手术前和手术后6个月和12个月进行了研究。高灵敏度CRP，血清淀粉样蛋白A（SAA）和白细胞介素-6（IL-6），以及葡萄糖和脂质代谢的标志物的血清浓度。结果：手术前，CRP水平升高相比，健康，正常体重的参考范围。CRP与胰岛素敏感性相关，如稳态模型评估（HOMA）指数所反映的，但当校正年龄和性别时，与BMI无关。在12个月时，手术将BMI从45降至31 kg/m2，CRP、SAA和IL- 6水平分别降低82%、57%和50%。CRP降低与基线HOMA呈负相关，与体重变化无关（r=-0.36，P=0.005）。在12个月时，HOMA < 4（胰岛素敏感）和HOMA > 9（胰岛素抵抗）的受试者中CRP分别降低了140%和40%，尽管BMI也有类似的降低。SAA和IL- 6的减少倾向于平行CRP的变化，但信息较少。结论：在病态肥胖的受试者，胃旁路手术降低能量摄入，减少炎症标志物，提高胰岛素敏感性。尽管体重显著降低，但在胰岛素抵抗患者中仅观察到对CRP水平的微小影响，表明循环CRP水平的灵活性主要取决于胰岛素敏感性而不是能量供应。
OBJECTIVE: Obesity is frequently associated with insulin resistance, dyslipidemia, hypertension and an increased risk of cardiovascular disease, reflected in elevated markers of inflammation, in particular C-reactive protein (CRP). To what extent the insulin resistance or the obesity per se contributes to increased CRP levels is unclear. In morbidly obese patients, gastric bypass surgery causes marked changes in body weight and improves metabolism, thereby providing informative material for studies on the regulation of inflammatory markers.DESIGN: Prospective, surgical intervention study of inflammatory markers in morbidly obese subjects.SUBJECTS: In total, 66 obese subjects with mean age 39y and mean body mass index (BMI) 45 kg/m(2) were studied prior to and 6 and 12 months following Roux-en-Y gastric bypass (RYGBP) surgery.MEASUREMENTS: Serum concentrations of high sensitivity CRP, serum amyloid A (SAA) and interleukin-6 (IL-6), as well as markers of glucose and lipid metabolism.RESULTS: Prior to surgery, CRP levels were elevated compared to the reference range of healthy, normal-weight subjects. CRP correlated with insulin sensitivity, as reflected by the homeostatic model assessment (HOMA) index, but not BMI, when corrected for age and gender. Surgery reduced BMI from 45 to 31 kg/m(2) and lowered CRP, SAA and IL- 6 levels by 82, 57 and 50%, respectively, at 12 months. The reduction in CRP was inversely related to HOMA at baseline independently of the change in body weight (r=-0.36, P=0.005). At 12 months, 140 and 40% reductions in CRP were seen in subjects with HOMA < 4 (insulin sensitive) and HOMA > 9 (insulin resistant) despite similar reductions in BMI. Reductions in SAA and IL- 6 tended to parallel the changes in CRP, but were less informative.CONCLUSION: In morbidly obese subjects, gastric bypass surgery lowers energy intake, reduces inflammatory markers and improves insulin sensitivity. Despite a marked reduction in body weight, only a small effect on CRP levels was seen in insulin-resistant patients, indicating that flexibility of circulating CRP levels is primarily dependent upon insulin sensitivity rather than energy supply.